Microsurgical reconstruction of major scalp defects following scalp avulsion

Abstract

Introduction:Total scalp avulsion is a serious injury, commonly occurring in Indian females working with industrial and agricultural machines. Their long hairs often get caught in a rapidly revolving machines, resulting in total avulsion of scalp. Lack of education and awareness in Indian villages often result in these patients coming late to the hospitals when replantation is not possible and scalp reconstruction remains the only available option.Materials and Methods:We performed our study on 22 cases of scalp avulsion injury presented to us between June 2007 and April 2012 at Department of Burn, Plastic & Reconstructive Surgery, SMS Hospital, Jaipur. In all of them a free tissue transfer was performed as an elective procedure.Results:Twenty two patients underwent free tissue transfer and followed up for an average period of 6 months. All patients included in this study were females with mean age of 28 yrs. Five patients in our study reported with partial necrosis of the free flaps which were subsequently managed with split-thickness skin graft (STSG). Two patients reported total necrosis of the flap which was re-operated using latissimus dorsi along with serratus anterior muscle (LDSA) from the contralateral side.Conclusion:As scalp avulsion because of rapidly rotating machine leads to large size defect not amenable for local tissue reconstruction. We performed reconstruction using LDSA and omental free flaps with split thickness skin graft (STSG) for large scalp defect and achieved good and stable soft tissue cover with satisfactory cosmesis.

Nonreplantable Total Scalp Avulsion Reconstruction with Acellular Biologic Matrix and Long-Term Outcome

“…In these circumstances, free tissue transfer for scalp coverage is commonly performed and reported in the current literature. , [5][6][7][8] The type of free flap employed can vary, pending the amount of tissue required as well as donor site availability. Reported flaps utilized have included latissimus dorsi muscle, rectus muscle, and omental fat 2,7 for large defects.…”

“…1,3 Although variability in avulsion pattern exists, the avulsed plane is typically the loose areolar layer of the scalp. 1,2 Reconstruction of total scalp avulsion defects can be both complex and complicated. Although ideal, scalp replantation is unfortunately uncommon.…”

“…Each reconstructive modality constitutes its own risk and benefit profile as well as donor site impact and associated morbidity. Free tissue transfer is commonly reported in the current published literature 2,[6][7][8] for coverage in the setting of nonreplantable tissue, however, there is a paucity of reported literature on the primary use of biologic products in this setting. We present a unique case of total scalp avulsion treated with porcine biologic matrix without the use of conventionally described reconstruction modalities, achieving complete skin closure and stable coverage with 4-year follow-up to date.…”

“…Total scalp avulsions are significant injuries, most commonly secondary to long hair trapped in high-speed rotary machines 1,3 . Although variability in avulsion pattern exists, the avulsed plane is typically the loose areolar layer of the scalp 1,2 . Reconstruction of total scalp avulsion defects can be both complex and complicated.…”

Bipedicle Frontal-Occipital Flap for Reconstruction of Post Avulsion Injury of Scalp Temporoparietal Region: A Case Report

“…The reconstruction of the scalp following avulsion injury has always been a great challenge for plastic surgeons. Although rare, scalp avulsion injuries mostly occur in working places and in female patients, it is often caused because of accidents related to their comparatively longer hair 1 . Selection of the flap for reconstruction either local or free depends on the location, size of the defect, and timing of surgery.…”